Dates

Scope of Practice (Provider's specialty)

NPI Data Dissemination. Special Note for Health Care Providers.

In September 2007, CMS began disclosing NPPES health care provider data that are disclosable under the Freedom of Information Act (FOIA) to the public.
The FOIA-disclosable data for a health care provider (individual or organization) who deactivated an NPI will now be disclosed within the files. For a deactivated NPI, CMS will only disclose the deactivated NPI and the associated date of deactivation within the files.

The NPI Registry and the downloadable files will contain data from the NPPES as reported to NPPES by you, or by someone acting on your behalf, or by an organization provider's Authorized Official.
If the downloadable file or the NPI Registry reflects information that is incorrect, health care providers should correct that information.

At any time, providers, or someone acting on their behalf, may edit their records by going to https://nppes.cms.hhs.gov, or by obtaining a paper NPI Application/Update Form (CMS-10114) from the NPI Enumerator or from the CMS forms page (http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms) and mailing the completed, signed form to the NPI Enumerator. Providers who need assistance in editing their records should contact the NPI Enumerator by phone at 1-800-465-3203, by email customerservice@npienumerator.com, or by letter: NPI Enumerator, P.O. Box 6059, Fargo, ND 58108-6059.

A sole proprietor is the sole (the only) owner of a business that is not incorporated; that unincorporated business is a sole proprietorship.

In a sole proprietorship, the sole proprietor owns all of the assets of the business and is solely liable for all of the debts of the business.

There is no difference between a sole proprietorship and a sole proprietor; they are legally a single entity: an individual.

In terms of NPI assignment, a sole proprietor is an Entity type 1 (Individual) and is eligible for only one NPI (the sole proprietorship business is not eligible for its own NPI).

As an individual, a sole proprietorship cannot be a subpart and cannot have subparts. (See NPI Final Rule for information about subparts.)

A sole proprietorship may or may not have employees.

Often, the IRS assigns an EIN to a sole proprietorship in order to protect the sole proprietor's SSN from disclosure in claims or on W-2s. NPPES does not capture a sole proprietorship's EIN.

Many types of health care providers could be sole proprietorships (for example, group practices, pharmacies, home health agencies).

4

Provider Last Name (Legal Name)

RADOVICH

The last name of the provider (if an individual). If the provider is an individual, this is the legal name. This name must match the name on file with the Social Security Administration (SSA). In addition, the date of birth must match that on file with SSA. (First and last names are required for initial applications.) The First, Middle, Last and Credential(s) fields allow the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.

5

Provider First Name

BELINDA

The first name of the provider, if the provider is an individual.

6

Provider First Line Business Mailing Address

4117 AVOCADO BLVD

The first line mailing address of the provider being identified. This data element may contain the same information as ''Provider first line location address''.

7

Provider Business Mailing Address City Name

LA MESA

The City name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address City name''.

8

Provider Business Mailing Address State Name

CA

The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address State name''.

9

Provider Business Mailing Address Postal Code

91941-7205

The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ''Provider location address postal code''.

10

Provider Business Mailing Address Country Code

US

The country code in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address country code''.

11

Provider First Line Business Practice Location Address

4117 AVOCADO BLVD

The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

12

Provider Business Practice Location Address City Name

LA MESA

The city name in the location address of the provider being identified.

13

Provider Business Practice Location Address State Name

CA

The State or Province name in the location address of the provider being identified.

14

Provider Business Practice Location Address Postal Code

91941-7205

The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.

15

Provider Business Practice Location Address Country Code

US

The country code in the location address of the provider being identified.

16

Provider Business Practice Location Address Telephone Number

619-251-7452

The telephone number associated with the location address of the provider being identified.

17

Provider Enumeration Date

08/12/2017

The date the provider was assigned a unique identifier (assigned an NPI).

18

Last Update Date

08/12/2017

The date that a record was last updated or changed.

19

Provider Gender Code

F

The code designating the provider's gender if the provider is a person.

20

Provider Gender

Female

The provider's gender if the provider is a person.

21

Healthcare Provider Taxonomy Code #1

1041C0700X

The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.

22

Healthcare Provider Taxonomy 1

Clinical

Healthcare Provider Taxonomy #1

23

Provider License Number 1

74344

Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.

24

Provider License Number State Code 1

CA

Provider License Number State Code #1

25

Healthcare Provider Primary Taxonomy Switch 1

Y

Primary Taxonomy:

X - The primary taxonomy switch is Not Answered;

Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);

N - The taxonomy is not the primary taxonomy.

Driving Directions to “BELINDA RADOVICH” Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic,
or other events may cause road conditions to differ from the map results.

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